Read: Building the workforce the NHS deserves
As the main political parties begin to lock horns on what are likely to be the big manifesto issues of a general election the NHS remains the hot topic, with workforce recruitment and retention at the top of the list.
The pandemic placed unprecedented demands on our health service and also exacerbated existing health disparities in the population. And for the NHS, this is against a backdrop of having to respond to significant population growth, an ageing population and an increasing proportion of people living with multiple chronic health issues. The complexity and volume of work has grown, alongside increasing public expectation that technological advances can be used to treat previously untreatable conditions. The Chancellors’ Autumn Statement confirming that the Government will produce an independent assessment of workforce needs across the NHS over the next five, ten and 15 years was broadly welcomed but, as yet, there is still no sign of a long-term strategy.
We know that record numbers of staff are leaving the NHS, with workplace stress, sickness and burnout, and pay restraints all commonly cited as the cause. Despite the fact that NHS figures for England show that more people joined the NHS than left it over the past decade, the number of vacancies has increased in recent years. In December 2022, there were 124,000 vacancies across the NHS, with 43,600 of those in nursing. NHS staff banks and external agencies plug the gaps but at a cost - in 2020/21 NHS England spent £2.44 billion on agency staff. The Government says it is on track to meet its target for 50,000 more nurses by the end of March 2024 although other health experts have expressed concerns that the demand for nurses is increasing faster than the supply. The goal of 26,000 more primary care professionals also appears to be on course but the problems raised by a declining number of GPs persist.
As part of its response, the Government recently launched its primary care plan. This included investment in telephone systems and staff training at surgeries alongside an expansion of the role of pharmacists, with less bureaucracy for GPs to allow them more time with patients. But increasing the number of full time equivalent GPs in the short and longer term by training and retaining them will continue to be necessary. The NHS needs to retain the entire range of staff – nurses, trainee doctors, pharmacists, midwives, health visitors, support staff, therapists and scientists - by making sure all staff are properly supported in their workplaces .
It is also likely that an apprenticeship system will be introduced as an alternative to the traditional medical degree route, perhaps as early as this September. NHS Trusts will be given funding to run five-year apprenticeships which will allow doctors and nurses to earn while they learn. Nurse apprenticeships have been running for some years, albeit not without problems. Financing the staff backfill costs whilst nurse apprentices undertake study has been a challenge for many NHS Trusts but up to one in ten doctors and a third of nurses could be trained through this vocational path in the coming years under the NHS workforce plan. Some health experts have raised concerns about how medical apprenticeships might be run, the impact on those students following the traditional route, and the capacity to scale up. However, the scheme could help to encourage those who may be deterred by the £80k average debt currently incurred by medical students.
Meanwhile, the Labour Party has said it will produce a 10-year plan to change and modernise the NHS if it is elected at the next general election. This would include a long-term workforce plan aimed at doubling the number of medical school places and creating 10,000 more nursing and midwifery clinical placements every year. Labour Shadow Health Minister, Wes Streeting, recently attended the launch of a Purpose Health Coalition campaign, Your local NHS: be at the heart of it, which highlights the jobs and opportunities the NHS can offer. This showcases the work many NHS Trusts are already doing to improve the situation for their staff, patients and communities. The Coalition has been working with Trusts and other health sector organisations to explore the impact of their solutions, including on recruitment and retention. By sharing best practice and ideas and working cross-party, it can help shape policies that will make a difference.
Addressing workload and workforce pressures in the NHS remains critical. It will require innovative thinking and bold strategies, with clear goals to monitor progress. Political parties need to listen and reflect the needs of the NHS’s most precious asset – its staff – if it is going to win the hearts and minds of voters and build an NHS fit for the twenty-first century.
